» Articles » PMID: 36932224

Neoadjuvant Therapy for Pancreatic Cancer

Overview
Specialty Oncology
Date 2023 Mar 18
PMID 36932224
Authors
Affiliations
Soon will be listed here.
Abstract

Patients with localized pancreatic ductal adenocarcinoma (PDAC) are best treated with surgical resection of the primary tumour and systemic chemotherapy, which provides considerably longer overall survival (OS) durations than either modality alone. Regardless, most patients will have disease relapse owing to micrometastatic disease. Although currently a matter of some debate, considerable research interest has been focused on the role of neoadjuvant therapy for all forms of resectable PDAC. Whilst adjuvant combination chemotherapy remains the standard of care for patients with resectable PDAC, neoadjuvant chemotherapy seems to improve OS without necessarily increasing the resection rate in those with borderline-resectable disease. Furthermore, around 20% of patients with unresectable non-metastatic PDAC might undergo resection following 4-6 months of induction combination chemotherapy with or without radiotherapy, even in the absence of a clear radiological response, leading to improved OS outcomes in this group. Distinct molecular and biological responses to different types of therapies need to be better understood in order to enable the optimal sequencing of specific treatment modalities to further improve OS. In this Review, we describe current treatment strategies for the various clinical stages of PDAC and discuss developments that are likely to determine the optimal sequence of multimodality therapies by integrating the fundamental clinical and molecular features of the cancer.

Citing Articles

Disulfidptosis: a novel gene-based signature predicts prognosis and immunotherapy efficacy of pancreatic adenocarcinoma.

Yin J, Li J, Wang H Discov Oncol. 2025; 16(1):308.

PMID: 40072658 PMC: 11904034. DOI: 10.1007/s12672-025-02053-w.


Neoadjuvant therapy-induced remodeling of tumor immune microenvironment in pancreatic ductal adenocarcinoma: a spatial and digital pathology analysis.

Li D, Liu Y, Lan R, Pillarisetty V, Zhang X, Liu Y Virchows Arch. 2025; .

PMID: 40014118 DOI: 10.1007/s00428-025-04056-y.


Endoscopic Ultrasound-Guided Radiofrequency Ablation for Pancreatic Adenocarcinoma: A Scoping Review with Meta-Analysis.

Tieranu C, Balaban D, Tabacelia D, Klimko A, Gheorghe C, Pereira S Diagnostics (Basel). 2025; 15(4).

PMID: 40002589 PMC: 11854302. DOI: 10.3390/diagnostics15040437.


Clinical Outcomes of Neoadjuvant Therapy Versus Upfront Surgery in Resectable Pancreatic Cancer: Systematic Review and Meta-analysis of Latest Randomized Controlled Trials.

Chan A, Zhao Y, Tan H, Chua D, Ng K, Lee S Ann Surg Oncol. 2025; .

PMID: 39987384 DOI: 10.1245/s10434-024-16674-y.


Nationwide implementation of the international multidisciplinary best-practice for locally advanced pancreatic cancer (PREOPANC-4): study protocol.

Stoop T, Seelen L, van t Land F, van der Hout A, Scheepens J, Ali M BMC Cancer. 2025; 25(1):299.

PMID: 39972248 PMC: 11841322. DOI: 10.1186/s12885-025-13554-w.


References
1.
Cai B, Lu Z, Neoptolemos J, Diener M, Li M, Yin L . Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg. 2021; 406(3):691-701. DOI: 10.1007/s00423-021-02080-5. View

2.
Katz M, Shi Q, Ahmad S, Herman J, Marsh R, Collisson E . Preoperative Modified FOLFIRINOX Treatment Followed by Capecitabine-Based Chemoradiation for Borderline Resectable Pancreatic Cancer: Alliance for Clinical Trials in Oncology Trial A021101. JAMA Surg. 2016; 151(8):e161137. PMC: 5210022. DOI: 10.1001/jamasurg.2016.1137. View

3.
Katz M, Merchant N, Brower S, Branda M, Posner M, Traverso L . Standardization of surgical and pathologic variables is needed in multicenter trials of adjuvant therapy for pancreatic cancer: results from the ACOSOG Z5031 trial. Ann Surg Oncol. 2010; 18(2):337-44. PMC: 3922125. DOI: 10.1245/s10434-010-1282-y. View

4.
Medrano J, Garnier J, Ewald J, Marchese U, Gilabert M, Launay S . Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma. Pancreatology. 2019; 20(2):223-228. DOI: 10.1016/j.pan.2019.12.001. View

5.
Grunwald B, Devisme A, Andrieux G, Vyas F, Aliar K, McCloskey C . Spatially confined sub-tumor microenvironments in pancreatic cancer. Cell. 2021; 184(22):5577-5592.e18. DOI: 10.1016/j.cell.2021.09.022. View